Alex Woodham introduces this case from CT Dent.

CBCT scanner: Instrumentarium OP300
CBCT imaging protocol: 60x60x80mm, 0.2 voxel
Effective dose: 0.06mSv
Clinical information: patient experiencing paraesthesia in lower right quadrant following implant placement.

Radiographic impression

Reconstructed panoramic.

Mandibular right premolar-molar region
The small arrows illustrate the mandibular canal. Both implants appear to interrupt/extend into the cortical boundary separating the alveolar process from the mandibular canal. A well circumscribed periapical radiolucency was observed associated with the apex of the mandibular right second premolar; the apex of tooth also exhibits hypercementosis
The more posterior mandibular implant exhibits a localised irregular area of low density lingual and inferior to the apex of the implant (circle) that appears to thin and potentially perforate the lingual cortical plate. The area may potentially represent osteotome penetration or localised inflammatory change. Careful clinical evaluation of the area is suggested to rule out a localised area of osteomyelitis

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